TOPICS IN GERIATRICS: High Intensity Interval Training in the Geriatric/Diseased Population, Grant Sigmon
Purpose
High-Intensity-Interval-Training (HIIT) has emerged as an alternative and/or complementary exercise prescription to continuous aerobic exercise. The rationale for this prescription is that it gives the patient the ability to impose high power outputs from peripheral muscles without overloading the cardio-respiratory system. The purpose of this paper is to provide education on the use of HIIT with the geriatric or diseased population.
Objectives
Define High-Intensity-Interval-Training
Outline Contraindications to HIIT
Provide Evidence on the use of HIIT
Provide an Outline of a HIIT schedule
High-Intensity-Interval-Training
HIIT involves alternating between short bouts (30 seconds to 5 minutes) of high-intensity exercise (80-90% max HR) with either active rest (50-60% max HR) or absolute rest for a period of time (1 to 5 minutes). Typically each training session ranges from 20-40 minutes. Traditionally HIIT has been used to train high level athletes but recently numerous studies have demonstrated the effectiveness of HIIT in the clinical population. The use of HIIT may result in more compliance from patients considering it is not as time consuming as the previous recommendations of physical activity (150 minutes per week).
Heart disease that limits exercise (valvar, congenital, ischemic and hypertrophic cardiomyopathy)
Complex ventricular arrhythmias or heart block
Severe chronic obstructive pulmonary, cerebrovascular disease or uncontrolled peripheral vascular disease
Uncontrolled diabetes mellitus
Hypertensive patients with blood pressure >180/110 (or uncontrolled)
Severe neuropathy
Research on HIIT in the older/diseased population
Enhanced Protein Translation Underlies Improved Metabolic and Physical Adaptations to Different Exercise Training Modes in Young and Old Humans. (Robinson, 2017)
“12 weeks of high-intensity aerobic interval (HIIT), resistance (RT), and combined exercise training enhanced insulin sensitivity and lean mass, but only HIIT and combined training improved aerobic capacity and skeletal muscle mitochondrial respiration. HIIT revealed a more robust increase in gene transcripts than other exercise modalities, particularly in older adults, although little overlap with corresponding individual protein abundance was noted. HIIT reversed many age-related differences in the proteome, particularly of mitochondrial proteins in concert with increased mitochondrial protein synthesis.”
High-intensity interval training in patients with lifestyle-induced cardio-metabolic disease: a systematic review and meta-analysis. (Weston, 2014)
“This meta-analysis has identified that HIIT has more physiological benefits than moderate intensity continuous training in patients with lifestyle-induced cardio-metabolic disease. HIIT significantly improved cardiorespiratory fitness by almost double that of MICT (19.4% vs 10.3%). This should translate into greater decreases in risks of morbidity and mortality. Incorporation of HIIT into a rehabilitation program may be a more achievable way for people with chronic disease to reach a level of exercise that promotes health enhancing benefits. These findings suggest that future exercise guidelines for lifestyle-induced cardio-metabolic disease should incorporate HIIT.”
Novel all-extremity high-intensity interval training improves aerobic fitness, cardiac function and insulin resistance in healthy older adults. (Hwang, 2016)
“All-extremity HIIT was feasible in older adults and resulted in no adverse events. Aerobic fitness (peak oxygen consumption; VO2peak) and ejection fraction (echocardiography) improved by 11% and 4%, respectively in HIIT, while no changes were observed in MICT and CONT. Greater improvements in ejection fraction were associated with greater improvements in VO2peak. Insulin resistance (homeostatic model assessment) decreased only in HIIT by 26%. Diastolic function, body composition, glucose and lipids were unaffected."
The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. (Jelleyman, 2015)
“Participants at risk of or with type 2 diabetes experienced reductions in fasting glucose compared with control. HIIT appears effective at improving metabolic health, particularly in those at risk of or with type 2 diabetes.
The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis. (Ramos, 2015)
“HIIT is more effective at improving brachial artery vascular function than moderate intensity continuous training, perhaps due to its tendency to positively influence cardiorespiratory fitness, traditional CVD risk factors, oxidative stress, inflammation, and insulin sensitivity.”
Modality – treadmill/hill, cycle ergometer (increase speed or incline for higher intensity interval)
Intensity- High intensity (HI) interval (80-90% max HR), Rest/Recovery interval (RI) (60% max HR)
Interval times- 4 x 4 min HI, 3 x 3 min RI
Warm up- 10 minutes at 60% max HR
Cool down- 5 minutes at 50% max HR
Summary
The use of HIIT in the geriatric/diseased population has proven to be beneficial and research shows it is more effective than previously prescribed moderate intensity continuous exercise. A thorough evaluation needs to be completed prior to initiating a high intensity exercise program and all participants should be cleared for physical activity prior to their participation. Other additional diagnoses that benefit from HIIT training include; management of congestive heart disease, COPD, intermittent claudication, type 2 diabetes, and frailty.
Resources
1. Robinson MM, Dasari S, Konopka AR, Johnson ML, Manjunatha S, Esponda RR, Carter RE, Lanza IR, Nair KS. Enhanced Protein Translation Underlies Improved Metabolic and Physical Adaptations to Different Exercise Training Modes in Young and Old Humans. Cell Metabolism. 2017 Mar 7; 25(3):581-592.
2. Kassia S Weston, Ulrik Wisloff, Jeff S Coombes. High-intensity interval training in patients with lifestyle-induced cardio-metabolic disease: a systematic review and meta-analysis. Br J Sports Med 2014; 48:1227–1234.
3. Hwang CL, Yoo JK, Kim HK, Hwang MH, Handberg EM, Petersen JW, Christou DD. Novel all-extremity high-intensity interval training improves aerobic fitness, cardiac function and insulin resistance in healthy older adults. Experimental Gerontology. 2016 Sep;82:112-9.
4. C. Jelleyman, T. Yates,G. O'Donovan, L. J. Gray, J. A. King, K. Khunti, M. J. Davies. The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obesity Reviews. Volume 16, Issue 11, November 2015, Pages 942–961.
5. Ramos, Joyce S, Dalleck, Lance C, Tjonna, Arnt Erik, Beetham, Kassia S, Coombes, Jeff S. The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis. Sports Medicine; Auckland 45.5 (May 2015): 679-692.
Purpose
High-Intensity-Interval-Training (HIIT) has emerged as an alternative and/or complementary exercise prescription to continuous aerobic exercise. The rationale for this prescription is that it gives the patient the ability to impose high power outputs from peripheral muscles without overloading the cardio-respiratory system. The purpose of this paper is to provide education on the use of HIIT with the geriatric or diseased population.
Objectives
- Define High-Intensity-Interval-Training
- Outline Contraindications to HIIT
- Provide Evidence on the use of HIIT
- Provide an Outline of a HIIT schedule
High-Intensity-Interval-TrainingHIIT involves alternating between short bouts (30 seconds to 5 minutes) of high-intensity exercise (80-90% max HR) with either active rest (50-60% max HR) or absolute rest for a period of time (1 to 5 minutes). Typically each training session ranges from 20-40 minutes. Traditionally HIIT has been used to train high level athletes but recently numerous studies have demonstrated the effectiveness of HIIT in the clinical population. The use of HIIT may result in more compliance from patients considering it is not as time consuming as the previous recommendations of physical activity (150 minutes per week).
Contraindications to Exercise
- Unstable angina pectoris
- Uncompensated heart failure
- Recent myocardial infarction (<4 weeks)
- Recent coronary artery bypass graft or percutaneous coronary intervention (<12 months)
- Heart disease that limits exercise (valvar, congenital, ischemic and hypertrophic cardiomyopathy)
- Complex ventricular arrhythmias or heart block
- Severe chronic obstructive pulmonary, cerebrovascular disease or uncontrolled peripheral vascular disease
- Uncontrolled diabetes mellitus
- Hypertensive patients with blood pressure >180/110 (or uncontrolled)
- Severe neuropathy
Research on HIIT in the older/diseased population- Enhanced Protein Translation Underlies Improved Metabolic and Physical Adaptations to Different Exercise Training Modes in Young and Old Humans. (Robinson, 2017)
- “12 weeks of high-intensity aerobic interval (HIIT), resistance (RT), and combined exercise training enhanced insulin sensitivity and lean mass, but only HIIT and combined training improved aerobic capacity and skeletal muscle mitochondrial respiration. HIIT revealed a more robust increase in gene transcripts than other exercise modalities, particularly in older adults, although little overlap with corresponding individual protein abundance was noted. HIIT reversed many age-related differences in the proteome, particularly of mitochondrial proteins in concert with increased mitochondrial protein synthesis.”
- High-intensity interval training in patients with lifestyle-induced cardio-metabolic disease: a systematic review and meta-analysis. (Weston, 2014)
- “This meta-analysis has identified that HIIT has more physiological benefits than moderate intensity continuous training in patients with lifestyle-induced cardio-metabolic disease. HIIT significantly improved cardiorespiratory fitness by almost double that of MICT (19.4% vs 10.3%). This should translate into greater decreases in risks of morbidity and mortality. Incorporation of HIIT into a rehabilitation program may be a more achievable way for people with chronic disease to reach a level of exercise that promotes health enhancing benefits. These findings suggest that future exercise guidelines for lifestyle-induced cardio-metabolic disease should incorporate HIIT.”
- Novel all-extremity high-intensity interval training improves aerobic fitness, cardiac function and insulin resistance in healthy older adults. (Hwang, 2016)
- “All-extremity HIIT was feasible in older adults and resulted in no adverse events. Aerobic fitness (peak oxygen consumption; VO2peak) and ejection fraction (echocardiography) improved by 11% and 4%, respectively in HIIT, while no changes were observed in MICT and CONT. Greater improvements in ejection fraction were associated with greater improvements in VO2peak. Insulin resistance (homeostatic model assessment) decreased only in HIIT by 26%. Diastolic function, body composition, glucose and lipids were unaffected."
- The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. (Jelleyman, 2015)
- “Participants at risk of or with type 2 diabetes experienced reductions in fasting glucose compared with control. HIIT appears effective at improving metabolic health, particularly in those at risk of or with type 2 diabetes.
- The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis. (Ramos, 2015)
- “HIIT is more effective at improving brachial artery vascular function than moderate intensity continuous training, perhaps due to its tendency to positively influence cardiorespiratory fitness, traditional CVD risk factors, oxidative stress, inflammation, and insulin sensitivity.”
High-Intensity-Interval-Training Aerobic Sample Schedule- Frequency – 3x per week
- Duration – 40 minutes
- Modality – treadmill/hill, cycle ergometer (increase speed or incline for higher intensity interval)
- Intensity- High intensity (HI) interval (80-90% max HR), Rest/Recovery interval (RI) (60% max HR)
- Interval times- 4 x 4 min HI, 3 x 3 min RI
- Warm up- 10 minutes at 60% max HR
- Cool down- 5 minutes at 50% max HR
SummaryThe use of HIIT in the geriatric/diseased population has proven to be beneficial and research shows it is more effective than previously prescribed moderate intensity continuous exercise. A thorough evaluation needs to be completed prior to initiating a high intensity exercise program and all participants should be cleared for physical activity prior to their participation. Other additional diagnoses that benefit from HIIT training include; management of congestive heart disease, COPD, intermittent claudication, type 2 diabetes, and frailty.
Resources
1. Robinson MM, Dasari S, Konopka AR, Johnson ML, Manjunatha S, Esponda RR, Carter RE, Lanza IR, Nair KS. Enhanced Protein Translation Underlies Improved Metabolic and Physical Adaptations to Different Exercise Training Modes in Young and Old Humans. Cell Metabolism. 2017 Mar 7; 25(3):581-592.
2. Kassia S Weston, Ulrik Wisloff, Jeff S Coombes. High-intensity interval training in patients with lifestyle-induced cardio-metabolic disease: a systematic review and meta-analysis. Br J Sports Med 2014; 48:1227–1234.
3. Hwang CL, Yoo JK, Kim HK, Hwang MH, Handberg EM, Petersen JW, Christou DD. Novel all-extremity high-intensity interval training improves aerobic fitness, cardiac function and insulin resistance in healthy older adults. Experimental Gerontology. 2016 Sep;82:112-9.
4. C. Jelleyman, T. Yates,G. O'Donovan, L. J. Gray, J. A. King, K. Khunti, M. J. Davies. The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obesity Reviews. Volume 16, Issue 11, November 2015, Pages 942–961.
5. Ramos, Joyce S, Dalleck, Lance C, Tjonna, Arnt Erik, Beetham, Kassia S, Coombes, Jeff S. The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis. Sports Medicine; Auckland 45.5 (May 2015): 679-692.